Complete the CMS-1500 claim form worksheet located in Appendix C. If you believe information provided in the following list is insufficient to adequately fill a required field with data, for example, to supply a specific diagnosis code, indicate this by typing N/A.
Name: Jane Smith
Insurer: TRICARE
Policy Number: 123456
ID number: 999000666
DOB: 01/01/1950
Gender: Female
Insured: James Smith, spouse
Address: 1111 Noname Court, Nowhere, NY 22222
Marital Status: Married
Patient’s Employer: Homemaker
Spouse’s Employer: U.S. Army
Nature of Condition: Routine exam
Patient Signature
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Complete the CMS-1500 claim form worksheet located in Appendix C. If you believe information provided in the following list is insufficient to adequately fill a required field with data, for example, to supply a specific diagnosis code, indicate this by typing N/A.
Name: Jane Smith
Insurer: TRICARE
Policy Number: 123456
ID number: 999000666
DOB: 01/01/1950
Gender: Female
Insured: James Smith, spouse
Address: 1111 Noname Court, Nowhere, NY 22222
Marital Status: Married
Patient’s Employer: Homemaker
Spouse’s Employer: U.S. Army
Nature of Condition: Routine exam
Patient Signature
To purchase this material click below link
http://www.assignmentcloud.com/HCR-220/HCR-220-Week-8-Checkpoint-Complete-a-CMS-1500-Claim-Form
For more classes visit
www.assignmentcloud.com
Complete the CMS-1500 claim form worksheet located in Appendix C. If you believe information provided in the following list is insufficient to adequately fill a required field with data, for example, to supply a specific diagnosis code, indicate this by typing N/A.
Name: Jane Smith
Insurer: TRICARE
Policy Number: 123456
ID number: 999000666
DOB: 01/01/1950
Gender: Female
Insured: James...